Health-care service utilization in substance abusers receiving contingency management and standard care treatments

• Published in: Addiction (Abingdon, England) Vol. 107; no. 8; pp. 1462 - 1470
• Main Authors: Olmstead, Todd A., Cohen, Jeffrey P., Petry, Nancy M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2012; Blackwell
• Subjects: Abusers; Addictive behaviors; Adult; Adult and adolescent clinical studies; Ambulatory Care - statistics & numerical data; Behavior Therapy - methods; Biological and medical sciences; Care and treatment; Clinical research; Clinical trials; Clinics; Community care; Community health services; Connecticut; Contingency learning; Contingency management; difference-in-differences; Drug abuse; Drug addiction; Drug addicts; Female; Health care; Health Care Utilization; Health facilities; Health Problems; Health Services - statistics & numerical data; Health services utilization; Help seeking behavior; Hospitalization - statistics & numerical data; Hospitals; Humans; Inpatient care; Male; Management; Massachusetts; Medical personnel; Medical sciences; Medical service; Medical treatment; Mental disorders; Mental health; Mental health care; Mental health professionals; Mental Health Services; Miscellaneous; Patient Acceptance of Health Care - statistics & numerical data; Patients; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Randomized Controlled Trials as Topic; Substance Abuse; Substance abuse treatment; Substance-Related Disorders - rehabilitation; Treatment Methods; Treatment Outcome; Trials; United States; Visits; Human; difference-in-differences; health services utilization; Drug addiction; Use; Substance abuse; Health service; Standards; Care; Treatment; Addiction; Contingency management; Reward; Comparative study; Public health
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/j.1360-0443.2012.03831.x

ABSTRACT Aim  To determine the impact of standard care and contingency management treatments on the utilization of general health‐care services by substance abusers. Participants, design and measurements  This secondary analysis pooled 1028 treatment‐seeking substance abusers from five randomized clinical trials that compared the effects of standard care (SC, n = 362) to standard care plus contingency management (CM, n = 666). In each trial, subjects in the CM condition showed significantly greater reductions in substance use than their SC counterparts. For each subject, utilization of 15 general health‐care services was measured 1 year prior to treatment intake and up to 9 months following treatment intake. Post‐intake utilization data were prorated to be comparable to the 1‐year pre‐intake data. Paired t‐tests evaluated changes in service utilization pre‐ and post‐intake, and difference‐in‐differences regression models were used to estimate the impact of CM, compared to SC, on changes in the utilization of each of the 15 health services. Setting  Out‐patient community substance abuse clinics in Connecticut and Massachusetts, USA. Findings  Utilization of several types of out‐patient services increased significantly between the pre‐ and post‐intake periods [e.g. dental visits (0.47, P < 0.001), community health center visits (0.50, P < 0.001), visits to a mental health professional office (1.03, P = 0.001)], while in‐patient hospital care for mental health problems decreased significantly (−3.50 nights, P < 0.001). A substantial portion of these changes occurred during the treatment period. No significant differences were found between the two treatment conditions. Conclusions  Initiating out‐patient substance abuse treatment is associated with changes in general health‐care service utilization, independent of the type of treatment offered.